ELECTROLYTES DESCRIPTION/USES HYPO HYPER

Sodium (Na) ● Higher in ECF HYPONATREMIA

135-145 mEq/L ● Regulates water in and out of cell ➢ Water is being pulled inside the cell causing it to swell HYPERNATREMIA
● Muscle contraction ➢ Na attracts water
Recommended ● Nerve impulses Causes ➢ Inc intake of salty food

⬇️
intake: ● Relaxes muscles in skeletal and cardiac ➢ Water is being pulled out of cell causing it to shrink
2.5g/day during na-k pump ● Consumption ➢ Dehydrated!
● Does not cross the wall ● Diuretics “thiazides” ➢ Develops from an excess water loss, frequently
● Regulated by ADH, thirst, and RAAS ● Vomiting, GI suction accompanied by impaired thirst mechanisms
● Diarrhea, sweating ➢ High aldosterone level
● Addison’s Disease
○ Low aldosterone Causes:

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○ Needed in maintaining blood pressure
Damage to adrenal glands
●
○ ⬆️
Cushing Syndrome
cortisol - ⬆️ ⬇️
Na; K
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○ ⬆️
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Secretion of ADH
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○
⬆️
Conn’s Syndrome
Aldosterone
independent and excessive aldosterone
○ Water is being kept
■ This dilutes the sodium production in the adrenal cortex
■ Common in px with heart failure ○ Potential for hypokalemia

○
■ Risk for hypovolemia
Oversecretion of vasopressin
●

●
○ ⬇️
Corticosteroids
Intake of water
Diabetes Insipidus
● Fluid overload
● Cardiac/Congestive HF ●
⬆️
Burns

⬆️
⬆️
● Renal failure ● Intake of Na
● Hypotonic solutions ● Hypertonic solutions
● Hyperactive bowel sounds ● Encephalopathy of any cause or cerebrovascular dx
○ Fluid moves from a lower concentration to a higher ● Hyperthermia, delirium, and coma
concentration. Since there is hyponatremia
○ Inc peristalsis

“SALT LOSS ” “NO FRIED FOOD FOR YOU”

S Seizure / stupor (brain swelling) F Fatigue

A Abdominal cramping R Restlessness, Really agitated
L Lethargic I Increased reflexes
T Tendon reflex is diminished (seizures/coma)
Trouble concentrating E Extreme thirst
L Loss of urine and appetite D Decreased urine output
O Orthostatic hypotension
Overactive bowel sounds Meds:
S Shallow respirations (late sx) ~ isotonic or hypotonic fluids
S Spasms of muscles
Reviewer: s/sx
● Mental confusion, personality changes, muscular weakness,
anorexia, restlessness, elevated BT, tachycardia, N&V,
● Severe: convulsions and coma

Chloride (Cl) ●
●
Associated with Na
Acid-base balance (bicarb)
HYPOCHLOREMIA
● GI related: vomiting, gastric juice, ileostomy ● ⬆️
HYPERCHLOREMIA
Na intake (hypertonic fluids)
98-106 mEq/L ●
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●
Digestion (Hcl)
Balances fluid with Na
Major ECF anion
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Diuretics “thiazides”
Burns
Cystic fibrosis!!!
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⬇️
Water draining / losing too much water
Bicarb (loss during diarrhea)
Conn’s syndrome
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● Bicarb,
○
⬇️
Metabolic alkalosis
chloride
They have an opposite relationship
●
●
Corticosteroids
Metabolic acidosis
○ Similar with hyponatremia and acidosis
 ● Fluid overload
● Heart failure or SIADH

S/sx : same with hyponatremia (dehydrated)

Potassium (K)

3.5-5.0 mEq/L
●
●
●
⬆️ ⬇️ ⬆️ ⬇️
Has opposite relationship with sodium
Na = K; K= Na
Found mainly inside the cell
HYPOKALEMIA
● Loop diuretics, corticosteroids, too much insulin
○ Too much insulin moves k into cell
HYPERKALEMIA
● Movement in and out of the cell
○ Due to burns and tissue damage
● Sodium is located outside (mainly) ● Cushing’s syndrome ○ Massive cell destruction!!!!
● Muscle contraction ● Starvation, losing too much K (vomiting/GI disturbances) ● Rhabdomyolysis (breakdown of muscles)
● Nerve impulse ● ST depression, inverted T wave, and prominent U wave ●
⬇️
Addison’s disease
○ aldosterone
■ Excreted Na but keeps K
● Renal failure
● K-sparring, ace inhibitors, nsaids

“Seven Ls ” “MURDER”

L Lethargic
L Low, shallow respirations M Muscle weakness
L Lethal cardiac dysrhythmias U Urinary output (little to none)
L Lots of urine R Respiratory failure
L Leg cramps D Decreased cardiac contractility
L Limp muscles E Early muscle twitches/cramps
L Low BP and heart R Rhythm changes
→ tall, peaked T waves
→ prolonged PR interval

Calcium (Ca)

9-10.5 mg/dL
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Bones / teeth
Muscles, nerves, clotting
Absorbed in GUT
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⬇️
HYPOCALCEMIA

⬇️
PTH due to surgery
Intake (lactose intolerant peeps)
HYPERCALCEMIA
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● ⬆️
Hyperactive PTH → releases too much CA
Vit D supplements intake
2.25-2.75 mmol/L Bones release Ca+ in the blood if there;s ● Low vitamin d ● Cancer spreads in bones which make it weaker
hypocalcemia and it weakens overtime ● Chronic kidney disease ● Thiazides, lithium = PTH are affected
Bound ● Bisphosphonates ● Tetany
● attracted to Factors in absorption: ○ Slows down the ability of the bones to release Ca ● Hypoactive bowel sounds
CHON ➢ Vitamin D into the blood ● Hypoactive deep tendon reflex
(albumin) ➢ PTH (Parathyroid) ○ It makes the bones stronger and avoids
➢ Calcitonin (Thyroid) osteoporosis
Ionized: ● Aminoglycosides “mycin”
● “Free” Ca ○ It wastes Ca via kidneys
● Active form ● Anticonvulsants
● Ecf ○ Affects vitamin D in the body
Trousseau’s sign Chovostek’s sign
“CRAMPS” “WEAK”

C Convulsions
R Reflexes are hyperactive W Weakness of muscles
E EKG changes
A Arrhythmias A Absent reflexes
→ prolonged QR interval Affected mental state
M Muscle spasms Abdominal distention
→ in calves and feet (tetany) K Kidney stone formation
P Positive signs
⇒ Trousseau’s sign
⇒ Chovostek’s sign
Paresthesia
 S Sensation of tingling/numbness
(paresthesia)

→ Excitement → Weakened

Magnesium (Mg)

1.3-2.1 mg/dl
●
●
●
Mainly located in ICF
Nerve, muscles, vessels
It makes the muscles relaxed and acts on ●
⬇️
HYPOMAGNESEMIA
● mg intake
Other electrolyte imbalance (K/Ca)
HYPERMAGNESEMIA
● Rare; this is due to trying to correct hypomagnesemia or
during labor and delivery
0.65-1.05 mmol/L blood vessels to maintain blood pressure ● Small intestine malabsorption ● Mothers are given magnesium sulfate during L & D
● Has a role in sodium-potassium pump ○ Could be caused by PPI ○ Nursing mx: monitor levels
Major anion in ECF ● Magnesium is binds with ATP ● Alcoholism ● Renal failure
○ It moves 3 Na+ out of the cell ● Malabsorption ● Receiving IV magnesium sulfate
and; ● Diabetic ketoacidosis ●
○ 2 K+ enters the cell
● Absorbed in small intestine “TWITCH” “LETHARGIC”
● Magnesium competes with calcium for the
binding spot
● No magnesium ⇒ continuous T Trousseau and Chvostek sx L Lethargic (prominent)

●
●
⬇️ Ca levels =⬇️
spasms/cramps/ contractions
Magnesium
Regulated by kidney and GIT
W Weakness
E EKG changes
→ prolonged PR/QT interval
I Inc deep tendon reflexes → widened QRS complex
T Torsades de pointes / tetany T Tendon reflexes are diminished
C Ca and K levels are low H Hypotension
ICF: A Arrhythmias
H Hypertension
● Skeletal muscle contractions, CHON
R Red/hot face
metabolism, ATP formation, Vit-B Complex
activation, DNA synthesis , CHON G GI issues
synthesis I Impaired breathing
C Confusion
ECF:
● Regulates blood coagulation & skeletal
contractility

Phosphorus (P) ● For teeth and bone building HYPOPHOSPHATEMIA HYPERPHOSPHATEMIA

● Stored in bones; absorbed in gut; excreted ● Aluminum antacids → blocks gut absorption ● Phosphate laxatives
3-4.5 mg/dl
0.97-1.45 mmol/L ●
in kidney
Regulated by parathyroid
● Starvation / refeeding syndrome
○ Because of starvation the tendency is to eat huge ● ⬆️
○ Fleet enema
Vitamin D intake

Phosphate and
○ Parathyroid gives signals to
kidney to inhibit absorption of
phosphate ●
○ ⬆️
amount of food causing increased insulin
BS → phosphate is then needed
Overactive parathyroid
●
●
●
Rhabdomyolysis : renal damage
Hyperparathyroidism
Chemotherapy
Calcium works in ● Vitamin D influence phosphate absorption ○ Inhibits kidney absorption of phosphate
opposite way ○ Low vitamin d levels S/sx
➢ Same with hypocalcemia
“BONE” ➢ Convulsions
➢ Reflexes are hyperactive
➢ Arrhythmias
B Bone pain / fracture ➢ Muscle spasms
O Osteomalacia ○ Calves / feet, tetany, seizures
→ bone softening/ leg bowing ➢ Trousseau and Chovestek’s sx
→ Rickets = short people
N Neuro status changes
→ irritable, confused, seizures
E Erythrocyte destruction
 HYPOVOLEMIA HYPERVOLEMIA

● Loss of ECF volume exceeded the intake of fluid ● High volume of water in the IV compartment
● ECF loss > fluid intake ○ Too fast IV infusion: pulmonary congestion/ pulmonary edema
○ Inadequate fluid intake ● Excessive oral intake, rapid IV infusion
○ Hemorrhage ● Heart failure. Kidney disease
○ Prolonged vomiting and diarrhea ● Excessive salt intake
○ Wound loss (burn injury) ● Administration of corticosteroids
○ Profuse urination or perspiration ● CVP: >10cm H2O
○ Translocation of fluids in abdominal cavity
● Hemoconcentration
○ Increased potential for blood clots, urinary stones
● Depletes ICF which can affect cellular functions = change in mental state
● Third-space fluid shifts , diabetes insipidus, adrenal insufficiency
● Osmotic diuresis, coma, diuresis, urination
● Hemorrhage
● Reabsorption
● ECF loss

Assessment Assessment:
➢ Thirst (earliest sx) ● Weight gain, elevated BP, increased breathing effort

➢ ⬇️ ⬆️
➢ Weight loss of >2lb/24hr
BP, T
➢ Rapid, weak, and thready pulse
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●
●
Dependent edema
Prominent jugular vein when sitting
Moist breath sounds (pulmonary congestion)
➢ Rapid and shallow respiration
➢ Scant and dark yellow urine Dx:
➢ Dry and small volume stool ● Hemodilution
➢ Warm and flushed skin , tented skin turgor, sunken eyes, clear lungs ○ Low blood cell count, low hematocrit
➢ Effortless breathing, weakness, flat jugular veins, reduced cognition, sleepy ● Low urine SG
➢ Dry mouth ● CVP greater than 10cm

Medical Mx: Medical Mx

❖ Inc volume of oral intake ● Tx of underlying cause
❖ Administer IVF placement ● Restrict oral and parenteral fluid intake
❖ Control fluid loss ○ Up to 250 mg of na/day
❖ Correction of fluid loss ● Elevate cx’s head, legs, change position q2hr
❖ Strict monitoring: I&O, weight, vital sx, CVP, LOC, breath sounds, skin color ● Apply elastic stockings
➢ CVP: 4
❖ Tx is based on severity of the fluid loss
❖ Renal function:
➢ Determine the cause of depressed renal function
➢ Prerenal azotemia
➢ Acute tubular necrosis
➢ Fluid challenge test
❖ Shock:
➢ 25% intravascular volume loss or rapid fluid volume loss
❖ Weakness, fatigue, cyanosis, oliguria, confusion
Rehydration drink:
● 2tsp sugar + ¼ tsp salt + ¼ tsp baking soda ; put in 1 liter of boiled water
● Caution:
○ Before giving it, have a taste and make sure it is does not taste more salty than a tear
● If available add a half cup of orange juice or coconut water or a little mashed ripe banana to the
drink

Function of bicarbonate:
● Maintains acid-base balance by functioning as primary buffer